Workers Compensation Claims Specialist; NE Region

Zurich is looking for an accomplished Workers Compensation Claims Specialist II to serve our Northeast region. This position offers a hybrid work schedule from our Parsippany or Boston offices, or a fully remote setup based in one of the following states:
Connecticut, Delaware, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont, Virginia, or West Virginia.

The Workers Compensation Claims Specialist will handle multi‑party commercial line Workman’s Compensation claims of low to high exposure and complexity within specific authority limits, ensuring claims are handled efficiently, effectively, and with a customer‑centric service approach.

• Document claims file by accurately capturing and updating claims data/information in compliance with best practices for low to moderate exposure and complexity personal or commercial line claims.
• Exercise judgement to determine liability by gathering and analyzing relevant facts, utilizing applicable law, and establishing basic principles of negligence.
• Exercise judgement to determine policy verification and coverage determination by analyzing applicable coverage for claims and determining whether the loss falls within the coverage.
• Work to have a timely resolution to claims by developing case strategy and case evaluation, and escalating issues as appropriate.
• Establish timely reserves and perform ongoing review throughout the claims cycle within authority limit by estimating and validating the value of claims.
• Assess damages by calculating applicable damages or range of damages allowed by law.
• Negotiate settlement of claim by establishing an appropriate negotiation strategy and utilizing available tools and resources within authority limits.
• Meet quality standards by following best practices.
• Ensure customer service by proactively communicating information, responding to inquiries, following customer protocols, and, when appropriate, participating in customer marketing efforts.
• Manage expenses by working within vendor approved networks and managing the scope of work assigned to outside contractors; depart from approved vendors with manager approval when in the best interests of the insured.
• Ensure legal compliance by following state and federal laws and regulations and internal control requirements.
• Refer claim to subrogation and fraud teams by identifying potential subrogation and fraud.
• Contribute to profitable growth by providing risk insight, information, and trends to the Business Unit or customer as needed.
• Protect Zurich’s reputation by keeping claims information confidential.
• Maintain professional and technical knowledge by participating in educational opportunities, staying current with industry trends, establishing personal networks, and participating in professional societies.

• Bachelor’s Degree and 3 or more years of experience in the Claims or Insurance area OR
• Zurich Certified Insurance Apprentice, including an Associate Degree and 3 or more years of experience in Claims or Insurance area OR
• Completion of Zurich Claims Training Program and 2 or more years of experience in the Claims or Insurance area OR
• High School Diploma or Equivalent and 5 or more years of experience in the Claims or Insurance area AND
• Must obtain and maintain required adjuster license(s).
• Knowledge of insurance regulations, markets and products.
• Microsoft Office experience.

• 4+ years of experience in the Workers Compensation line of business.
• 3+ years of experience handling litigation management.
• Specialization in PA jurisdiction with knowledge of NJ and/or VA jurisdictions.
• Learn and handle additional jurisdictions as needed.
• EDI filing requirements.
• MSA/Medicare knowledge.
• WCCA, WCCP Designations.
• Knowledge and skill of claims handling.
• Negotiation experience.
• Experience in line of business.
• Excellent communication skills.
• Analytical skills.

Your pay at Zurich is based on your role, location, skills, and experience. We follow local laws to ensure fair compensation. You may also be eligible for bonuses and merit increases. If your expectations are above the listed range, we still encourage you to…